Medical scribes are used in variety of clinical settings to complete clerical tasks otherwise done by a clinician. Limited research has been done concerning the effects of scribes on physician productivity in emergency medicine settings. In this randomized controlled trial from Australia, data were collected from 589 scribed shifts (5,098 patients) and 3,296 non-scribed shifts (23,838 patients) to study physician productivity (the mean number of patients per hour per doctor, and number of primary consultations) and patient throughput (door-to-doctor times, emergency department length of stay times, etc.) Researchers found that scribes increased physician productivity from 1.13 (95% CI 1.11 to 1.17) to 1.31 (95% CI 1.25 to 1.38) patients per hour per doctor, representing a 15.9% increase (p<0.001) as compared to physicians without scribes. Primary consultations, defined as consultations in which the physician was the patient’s main physician, also increased, from 0.83 (95% CI 0.81 to 0.85) to 1.04 (95% CI 0.98 to 1.11), representing a 25.6% increase (p<0.001). Moreover, the median emergency department length of stay was shorter in the scribed group (173 minutes, IQR 96 minutes to 208 minutes) than in the non-scribed group (192 minutes, IQR 108 minutes to 311 minutes, p<0.001). There was no difference in the median doctor-to-door time between the scribed and non-scribed groups. There were 16 patient safety incidents that involved scribes; the most common error category was patient identification. In 50% of these incidents, the scribe played an active role in preventing a medical error. This study was limited by the fact that junior doctors were excluded, and that the study was conducted in a single Australian state. Nevertheless, this is the first randomized, prospective study of the use of scribes in an emergency department setting. Results from the study show that the use of scribes may increase physician productivity and decrease the length of emergency department stays.
Click to read the study in BMJ
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